First Night, Any Further Improvements?

[bradjn]

First night with a lightly used Resmed Aircurve 10 VAuto.

I went for a sleep study and about 2 years ago, and was set up on an older machine.  Used for a couple of nights, but it inflated me like a balloon.... 

Recently bought an oximeter and didn't like the dip in my blood o2 levels through the night, so I bought the newer Resmed machine online.  Would like to calibrate with the help of this forum as opposed to being subjected to another sleep study.

Biggest detractor is I thought the new machine would help me not swallow or consume air, unfortunately not the case.  It doesn't seem as bad as the older machine, but certainly not enjoyable.  Is the swallowing air common? would love to hear from others who have dealt with it succesfully.

Thank you!

[Crimson Nape]

Hi bradjn! -

We really need to see a complete picture of your night's data. When in the Daily screen, press the F12 key for a complete screenshot. Please post that image here. One question, how did you arrive at a PS value of 4? That could be the reason for all, or most, of your CA's.

[bradjn]

Crimson Nape - thank you for responding.  Here is the screen grab.

The PS Value of 4 was already programmed in the machine.

I appreciate your time and hope the attached provides you the information you requested.

Bradjn

[Sleeprider]

You need to revise the settings. The high number of CA can be reduced by dialing back pressure support. Very simple to access the settings: https://www.apneaboard.com/resmed-airsen...setup-info

We really need the full night of data and not the zoom of 1:48 to 1:50:50. That will allow us to see the relationship of pressure to events. Even without seeing that, I think your settings should be EPAP min 4.0, PS 2 Max pressure 9.0. Hopefully we will see if this avoids all the CA events and is adequate to achieve efficacy with obstructive events without filling you up with air. These settings are not picked at random. Lower pressure support will diminish CA and your 95% EPAP pressure was under 9.0. So we can get you closer to good therapy without the centrals and hopefully aerophagia.

[bradjn]

    The difference after making the suggested changes was dramatic and instant.  For the first time on a CPAP I wasn't inflated like a balloon during the night.  The first part of the night must have been so restful that I was up for a couple of hours, during which I took of the machine - hence the gap.  The subsequent nights have not been as profoundly good, not sure why, but still not swallowing air which is a great thing!  Thank you!!

[Sleeprider]

I'm going to suggest adding 1-cm to EPAP and max IPAP and PS 4.0 but increase Trigger Sensitivity to High. Watch your sleep position as obstructive events look positional (chin-tucking). It's not to the point I will recommend a soft cervical collar, but that cluster at 03:00 on March 1 has me thinking. Read th e positional apnea section of the Optimizing therapy wiki http://www.apneaboard.com/wiki/index.php...onal_Apnea

EPAP min 5.0, Max IPAP 10.0, PS 4.0. If aerophagia returns, drop max IPAP to 9.0. The increased trigger sensitivity should help reduce the CA, but if not, we will slow reduce pressure support as the next step.

[bradjn]

Sleeprider, 

I appreciate the continued feedback/support.

In reviewing your comments, I kept your original settings and made as best an effort to focus on better sleep position.  I did away with the pillow.  I notice during the ramp up period that nasal breathing feels blocked with the full face mask, despite no noticeable issues breathing through the nose without the mask.  This trend has played out most nights.  just a sidebar, obviously fall asleep anyway.


Would love your feedback on this latest data set.

Regards,

Bradjn

[Sleeprider]

Nasal congestion can arise from pressure on the sinuses from the frame or cushion of a full-face mask. That is why I greatly prefer nasal pillows, I am very sensitive to such pressure, and will stuff-up immediately from it. The cause may be different for you. Your latest charts show a higher CA, however you have had lower event rates with the same pressure settings of PS 2 over 4.0 to 9.0, so I'm inclined to fall back on the idea central events are consistently inconsistent. There are no events when pressure is lower, so at the risk of having a few more OA, perhaps try a maximum pressure of 8.0. It seems like the CA events flare up only after an OA or flow limitation pushes your pressure higher. I see a tendency for flow limitation to rise in a manner that suggests positional issues are at work, where your airway is restricted with curvature in your neck.

[bradjn]

Hello,

So I did away with all but a very thin pillow, and went ahead and got a cervical collar to prevent chin tuck, which I did become aware of after it was brought to my attention by the moderators.

My O2 ring is giving me clear marks, with no dips below 92% oxygen and a stable 97-98% saturation throughout the night, but I am still seeing readings in the 7-10 AHI range off my CPAP.

Hoping some light might be shed on the updated situation.

Regards,

Brad

[Sleeprider]

With Autoset pressure of 6-8 and EPR 2 your pressure is at maximum most of the time. We need a closer zoomed look at the central events to determine why they occur, but it appears you would benefit from a pressure range of 8-10 at least.